Abstract:Pyroptosis is a form of programmed cell death characterized by prominent inflammatory responses. As a classic chronic inflammatory disease, atherosclerosis (As) has been demonstrated to exhibit specific expression of multiple pyroptosis-related proteins within plaques. Accumulating evidence indicates that pyroptosis plays a crucial regulatory role in the initiation and progression of As. This review primarily focuses on three key cell types involved in As—endothelial cell, macrophage, and vascular smooth muscle cell (VSMC), and systematically summarizes their pyroptotic mechanisms and contributions to atherosclerotic development. Furthermore, we comprehensively summarize current advances in anti-atherosclerotic drugs and bioactive compounds targeting pyroptosis, aiming to provide theoretical foundations and research perspectives for developing novel strategies for the prevention and treatment of As.